The UK has some of the highest prevalence rates of allergic conditions in the world, with over 20% of the population being affected by one or more allergic disorder. Many of these people will participate in outdoor activities and therefore it is important to have some knowledge of how to manage allergies when out on the hill.
What is an Allergy?
An allergy occurs when someone reacts to something that is normally harmless, such as pollen, food or an insect sting. The term “allergy” encompasses a spectrum of conditions and symptoms, ranging from mild hay-fever through to full blown anaphylaxis, which can be life threatening.
As with all medical conditions and outdoor activities, being proactive and having an appropriate written screening proforma, or checking for any medical issues verbally at the start of any session, is always better than discovering someone has a problem as it is occurring.
It is important to understand what someone means when they say they have an allergy.
Asking what happens to them when they are exposed to a trigger will allow you to determine the severity of any reaction and discuss about any mitigation strategies that may be required for example advising the rest of the group not to bring any nuts on the hike.
If in doubt or at all concerned, you should ask the participant to obtain additional information and guidance from their doctor.
The most common symptoms and triggers are listed above, but theoretically someone can have an allergy to anything! Luckily, most of the time, allergy sufferers know what they are allergic to, and will usually have a suitable management plan in place to address this.
Management of simple allergies:
Hay-fever, also known as allergic rhinitis, causes nasal congestion and persistent cold-like symptoms. It is one of the most common allergic disorders in the UK, affecting almost half the population to some extent. It is often accompanied by sore, itchy and watery eyes and a sore tickly throat. It can be debilitating for sufferers and have a profound effect on their ability to participate in activities.
The mainstay of allergy treatment is avoidance, however this is not always practical, particularly if people want to engage in an active outdoor lifestyle! Therefore, medications are typically used to try and manage symptoms:
Antihistamines: these are available as creams or tablets. Tablets work better as a preventative measure and are easy to source from a chemist and most supermarkets. These work by suppressing the body’s allergic response and can be very effective.
Participants with allergies should ideally have a supply of these with them, but it is also worth having a backup packet in your medical kit. It is important to choose a non-drowsy antihistamine such as loratadine, as you don’t want people participating in outdoor activities to become drowsy and risk sustaining an injury. (Note that some people can still get drowsy when taking “non-drowsy” antihistamines)
Eye drops: a range of eye drops are available to help with the typical watery itchy eye symptoms than many sufferers experience. Lubricating drops can help to combat the symptoms of itching and dryness, however it is better to use sodium cromoglicate drops, which can reduce or prevent symptoms occurring if used prior to allergen exposure.
Nasal sprays: these can be a great strategy to improve symptoms, however they need to be used regularly to get maximal impact. These usually contain a mild steroid which reduces the level of inflammation in the nose and sinuses. In turn, this reduces the amount of congestion and nasal discharge.
Creams and Ointments: moving away from hay-fever, people can often develop allergic rashes in response to a range of triggers. These can be intensely itchy with raised bumps on the skin. Similarly, insect bites and stings can cause redness, swelling, pain and itching.
Antihistamine creams and ointments are often helpful in these cases, and sometimes using a mild steroid cream, such as hydrocortisone 1%, can be beneficial for inflamed bites. It is important to advise participants to see their doctor or a pharmacist, if a rash is worsening despite treatment or if they are having to use these creams for longer than 3 days.
Severe Allergic Reactions and Anaphylaxis
The fear at the back of most people’s minds when they hear the words “allergic reaction” is anaphylaxis. An anaphylactic reaction occurs when the body releases a concoction of chemicals in response to a particular trigger. This causes a range of life-threatening symptoms and is a medical emergency.
Most of the time, a participant will know that they are at risk of anaphylaxis and consequently they should have two adrenaline auto-injectors issued by their doctor. These auto-injectors are designed to be easy to use, can be used through clothing, and have helpful pictures on the side explaining how they should be used. There are three main manufacturers Epipen, Jext and Emerade.
Note: If you are taking groups out on the hill, you should have completed an outdoor first aid course that covers how to use these, and depending on your experience, qualifications, and where you work, you may have one of these in your first aid kit.
Crucially, if you suspect anaphylaxis, you should call 999 immediately, even if the patient has used their auto-injector and now feels ok, as they need to be transferred to hospital for ongoing monitoring and assessment. This is vitally important as they can develop a subsequent second or delayed reaction which may require additional doses of adrenaline.
If there is no response to the initial injection, current recommendations are to give a further adrenaline dose after 5 minutes. This is why people at risk of developing anaphylaxis should always be issued with 2 injector pens.
Whilst waiting for the ambulance or mountain rescue, it is important to lie the patient down as they often have low blood pressure, and you don’t want them to faint and injure themselves. It is also important to consider the outdoor environment and manage this accordingly with a bothy bag or emergency shelter, to ensure that they do not get cold.
This article has briefly introduced the topic of allergy and cannot comprehensively cover it in detail. If you want to find out more, please look at the following resources or consider purchasing the Oxford Handbook of Expedition and Wilderness Medicine 3rd Edition.
Allergy UK: https://www.allergyuk.org/
NHS UK allergy: https://www.nhs.uk/conditions/allergies/